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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Tod Mijanovich, MPA, John Billings, JD, and Nina S. Parikh, MPH. Wagner Graduate School of Public Service, New York University, Center for Health and Public Service Research, 726 Broadway, 5th Floor, New York, NY 10003, 212-998-7467, tod.mijanovich@nyu.edu
This presentation will describe the development and use of an algorithm that classifies ED administrative records based on discharge diagnosis. The algorithm identifies five major categories of encounters: 1) non-emergent; 2) emergent but treatable in a primary care setting; 3) ED care needed but preventable with the receipt of timely primary care; 4) ED care needed and unpreventable; and 5) unclassified. The algorithm was developed in consultation with a doctor panel that reviewed 5,700 medical records from New York City emergency departments. The medical records included information on presenting and discharge diagnoses, vital signs, and resources used. Because the algorithm includes a category of unpreventable ED visits, it can be used to develop reliable ratios of the number of non-emergent to the number of ED-needed encounters, which can proxy for encounter rates in the absence of complete encounter data or population denominator data. Analysis of an ED record database comprising 85% of the 1998 ED encounter data in New York City reveals significant differences in types of care by ED, insurance status, gender, race, and time period. For example, ¾ of New York City’s ED visits in 1998 were for conditions that were either non-emergent (41%), or emergent but treatable in a primary care setting (34%). We will present results for our continuing analysis of New York City ED records through 2000. This algorithm provides a powerful method of monitoring ED utilization, as well as indicating whether patients are achieving adequate access to primary care services outside the ED.
Learning Objectives:
Keywords: Emergency Department/Room, Access to Health Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.